Provider Demographics
NPI:1083277933
Name:MAKI, STEPHEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MAKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 343
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-0343
Mailing Address - Country:US
Mailing Address - Phone:207-778-8969
Mailing Address - Fax:207-897-9082
Practice Address - Street 1:148 MAIN ST
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-1506
Practice Address - Country:US
Practice Address - Phone:207-897-9080
Practice Address - Fax:207-897-9082
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4626333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy